Bilateral Mandibulectomy - Fractures

Case Summary:

As noted in other posts, removing or shortening the mandibles can be a needed procedure. Most patients are more comfortable and can have a relatively cosmetic outcome. Almost all behave as if nothing is wrong within a few days to weeks after the procedure. Sometimes the mandibles are removed due to oral tumors. Other times, disease of the teeth progresses to mandibular fracture and the disease usually has insufficient bone quality preventing repair. This is a case of a bilateral mandibulectomy due to multiple pathologic fractures secondary to periodontal disease.

Patient Information:

Coley Kay is a 10 year old spayed female Shih Tzu, owned by Judy Lukemyres. She presented after a fall. Dr. Deb Conant from Bright Eyes and Bushy Tails in Iowa City, IA did a great job determining that Coley Kay had fractured her mandibles. Coley Kay was sent our way to determine if a repair or other treatment was needed.

Below: Front and profile views of short mandibles on presentation

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Dental Exam Findings:

Coley Kay is severely brachycephalic and already had an almost ‘flat face.’ The fractures were present at the mid to caudal mandible at each lower first molar.

Advanced Imaging:

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Above: CT slice with insufficient bone to be able to repair

Procedures Performed:

Bilateral mandibulectomy through the fracture sites along with removal of the diseased teeth. Coley Kay presented with only 7 of the 42 teeth remaining. Four of those 7 teeth were the structural, important teeth, yet all 7 were diseased beyond repair. The upper canine had a communication between the nose and the mouth (oral nasal fistula). All teeth remaining were removed and the small thin mandible portions were removed from the fracture sites forward. A cosmetic closure while rebuilding the lip vestibule to aid in retaining saliva was performed. The tongue will hang out, but it had done so often prior to the fall.

The oral nasal fistula site was closed by making a wide tension free flap with specialized surgical closure to aid in providing support for areas unsupported by bone.

Before SURGERY:

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VIDEO:

Demonstrates fracture site mobility before surgery

After SURGERY:

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Follow-Up Information:

While the mandibles are now much shorter, they are approximately 1cm shorter than the maxilla allowing for function to remain and still have a relatively cosmetic outcome.

Below: Coley Kay, thriving after a successful mandibulectomy. A happy and healthy transformation!